Friday, January 23, 2015

Bullying
is a major problem in schools and workplaces all over the world. It is a
“multifaceted form of mistreatment, characterized by the repeated exposure of
one person to physical and/or emotional aggression including teasing, name
calling, mockery, threats, harassment, taunting, hazing, social exclusion or rumors” (17).
The World Health Organization has documented a wide range of bullying
prevalence worldwide. As all
public health and societal problems, bullying is the consequence of a complex
network of socially constructed image and personality stereotypes and ‘labels’
promoted and fueled by mass media, interconnected discriminatory behaviors and
actions against people from with different race/ethnicity, gender, sexual
orientation, body image, and even hobbies and interests. In the realm of public
health, bullying is an enormous problem—it is the emotional and/or physical
abuse that has detrimental effects not only in the physical and mental health
of the victim—even mortality, but also on their academic/professional
performance, self-esteem, continuous systematic and interpersonal
discrimination of ethnic/sexual minorities, and future of the victim as
possible victimizer.

The
U.S. government’s StopBullying.gov campaign is failing to protect victims and prevent
further victimization of individuals in schools, as most of its proposals are
innately misled from individual health behavior models, such as the Health
Behavior Model, the Transtheoretical Model, and the Theory of Planned
Behavior—as analyzed below, the approach towards bullied students fuels
victim-blaming and helplessness, the response towards bullies fails to address
the roots of the abuse, and the advice for parents and teachers is not strong
enough to change their behavior in a progressive, understanding, way, maybe
only their attitudes—then they become an authoritative figure nobody wants to
listen to. Today’s Western value system emphasizes the ability of the
individual to control his or her own personal fate. However, this focus on the
connection of social conditions to single diseases via single mechanisms at
single points in time neglects the multifaceted and dynamic processes through
which social factors may affect health and, consequently, may result in an
incomplete understanding and an underestimation of the influence of social
factors on health (11).

Social
epidemiologists and psychologists have continuously concluded
“multidisciplinary efforts are needed at a community level to provide effective
interventions” (13). There is also an urgent need to reframe the issue (22) in
the social construct of how bullies, victims, and bystanders react.
StopBullying.gov fails to acknowledge and respond to the intersectionality of
other oppressive systems that facilitate bullying, such as racism, discrimination,
sexism, homophobia, stigma, domestic violence, mass media reach and patriarchy.
We urgently need a “reconceptualization of lifestyle” (7) in collective action
instead of individual, self-interested competition. The intervention
#WeAreAllWorthy is a multidimensional movement using social networks, allyship,
the urge for safe spaces, good citizenship, and the prevention, protection, and
respect of basic human rights for all to defeat bullying.

The Federal Government’s campaign’s advice to victims
is, “If speaking up seems too hard or not safe, walk away and stay away. Don’t
fight back. Find an adult” (19). This advice is innately flawed because of
three reasons, all connected to individual health models with wrong assumptions
or to a wrong approach to social health models.

First, asking children to walk away and not fight back
automatically gives more power and control to the bully. Control is a crucial
core value that people want in their lives, and by giving it to the bully, the
victim feels even more dependent on and further victimized by the system.

Second, this continued “victim-blaming” of the
campaign, through further Labeling, saying not to provoke or go near the bully,
not to fight back or speak back at them, only strengthens the victim’s
hopelessness: if he/she’s the victim and the system is telling him/her that
it’s impossible to fight back and one must only stay away, it’s turning the
blame on the victim for being in the same space as the bully. It’s like blaming
a rape victim for what she’s wearing or what party she was in instead of
blaming the rapist or the bully for the abuse.

Third, the campaign tells students to report to the
school, but often this reporting is not anonymous and the victim sufferes
further abuse—this point thus assumes that the victim is in a vacuum and that
the environment is receptive to reports. Social Cognitive Theory (15) is the
least restrictive of the individual models, but it still assumes a dynamic,
ongoing process in which personal factors, environmental factors, and human
behavior exert influence upon each other” (14). The intervention is asking too
much of the victims- if the environment is abusive, violent, and full of stigma,
its influence on the individual’s thoughts and actions will be negative and
victims will not feel comfortable or safe reporting to a school that continues
to fail them.

Critique Argument 2: Punishing the Bullies
Fails to Address the Roots of Abuse

The
campaign follows a traditional approach towards the bullies, or abusers,
punishing them in the same way that other students are punished for completely
different reasons. Bullying is thus treated in school rules as just one more
behavior that is forbidden, yes, but not adequately handled. Bullying is a much
more complicated problem than smoking, or eating in class, or speaking during a
test—this abuse permanently scars the emotional and physical health of another
human being. Following are three reasons why this privation of freedom is
counterproductive and also fails to address the roots of the abuse.

First,
bullies are punished through not being able to go outside during recess, or an
extra study period, etc. and also sometimes through forced instructions on how
to stop bullying other students. This is based on the Transtheoretical Model (9),
which concludes that a model where change takes place in stages is best
(Pre-contemplationà contemplationà preparationà actionà maintenance). Unfortunately, it not only
fails to find incentives for good behavior and maintenance of that good
behavior, but it also doesn’t even consider the roots of the abuse. Bullies
aren’t going to sit during lunch break on Monday contemplating how their abuse
might be hurting their victim, and by Thursday they’re Most Compassionate Student. Any trigger, such as being abused
themselves, can absolutely take them to an unpredictable jump, backwards or
forwards in this model.Furthermore,
the alternative model of Psychological Reactance (18) states that whenever an
individual feels that its freedom is being threatened, it will do whatever it
takes to restore that anxiety and get that freedom back. This means that
anytime a student is punished at school for bullying or breaking any other rule,
they’ll react to that threat or that punishment by exerting their power and
control over other students even more than before. The bully wants to maintain
his/her position of power and autonomy to call others names or beat others up,
so maybe

Second—and
maybe the most important failure of this campaign, is that it doesn’t directly
address the psychological causes of bullying. Teachers recognize that the abuse
may be a consequence for past or parallel victimization of the abuser, but in
the context of school rules and action steps, the bully is not a victim, but a
rule-breaker. Studies have continuously shown that the victim-bully cycle is
fueled by the Social Learning Theory (the most comprehensive of the individual
theories). Studies of violence and abuse have discussed the role of social
learning theory in the victim-offender cycle of abuse, finding that “victims of
abuse are often more likely to be disruptive, aggressive, and violent than
their non-abused counterparts” (12, 15).

Third,
the campaign explicitly tells kids to “be nice” (which again touches on
Psychological Reactance), but it fails to consider the social norms of schools
and of mass media telling kids that abuse and name-calling increases the social
status of the bully within their individual social networks. The campaign is
advocating for the Theory of Planned Behavior (9), where individuals should go
through a rational, cognitive decision-making process. However, this model
fails to consider subjective norms associated with that behavior. Even if the
bully considered decreasing or stopping the aggression, peer pressure of more
bullies or of the popular or ‘cool’ kids in the school would encourage him to
act irrationally and continue the violence.
Some bullies are bullied to bully, and individual models fail to
recognize the social network where students face this stigma, abuse, and norms.

Critique Argument 3: How Adults Are
Promoting the Wrong Values

StopBullying.gov
also has an unrealistic and incomprehensive approach towards teachers and
parents in the community. The campaign fails to understand the unrealistic
optimism of parents who don’t believe in bullying and teachers who choose to
ignore the problem; it also stresses the adults’ attention on victim-blaming
again; lastly, it fails to recognize the social norms of reinforced prejudice
and stigma that kids mimic from adults around them.

First, it is worth mentioning again
the Health Behavior Model’s (9) assumption that it’s the victim’s fault that he
or she is being bullied. The model states that each individual considers
his/her perceived susceptibility, severity, benefits of action, and barriers of
action—meaning the costs and benefits of particular actions, which should
result in rational decision-making. This
theory then rationalizes that a situation of youth violence is a consequence of
a victim not measuring the costs and benefits of their behavior correctly and
ending up in the wrong place at the wrong time.

Second, this campaign fails to
acknowledge the predictable irrationality (1) of the parents and teachers who
are supposed to be role models and examples for their students and children. As
the adults in the community, these individuals are responsible for not only
advocating for kindness, respect, and equality, but also for showing these behaviors and actions by
example. The campaign fails to address the normalized and institutionalized
racism, sexism, prejudice, homophobia, and abuse within families, communities,
and workspaces also. If students are being told not to bully but they’re being
shown violence, discrimination, and injustice, they’re going to mimic the
behaviors and silence the advice. (15)

Third, the campaign is unaware of
the Theory of Optimistic Bias and of the Law of Small Numbers, therefore,
parents and teachers choose to ignore signs of abuse rationalizing it as
unlikely to happen to their students
or their children. These theories
have shown how that people tend to think they’re invulnerable, but they expect
others to be victims of misfortune, not themselves. Studies have repeatedly
confirmed that “cognitive and motivational considerations lead to predictions
that degree of desirability, perceived probability, personal experience,
perceived controllability, and stereotype salience would influence the amount
of optimistic bias evoked by different events” (21). Therefore, just as police
departments and administrators of universities deny sexual assault prevalence
in their schools because it must be sure
happening somewhere else, but not here, teachers and parents rationalize
that because they didn’t suffer bullying or because they’ve never seen
it—because they know only a few kids who aren’t bullied they assume nobody is,
especially their kids (Law of Small Numbers), they don’t assume the problem
with all of its complex causes and connections to other forms of violence,
aggression, and bad parenting or teaching.

Intervention idea: #WeAreAllWorthy

The
StopBullying.gov campaign is failing to recognize the importance of social
health behavior models. It isn’t acknowledging the negative impacts of victim
blaming, the strong propaganda-like effects of violent, disrespectful,
competitive behavior of celebrities and TV stars in their shows and movies and
in real life. The campaign also fails to recognize the victim-bully cycle and
the psychological causes of youth abuse. It doesn’t create safe spaces where
victims, allies, and victimizers can safely learn about stigma, about community
values, or about taking control of their own safety and actions through a
collective effort of everyone remotely involved. Most importantly, the campaign
fails to identify the real cause behind bullying, discrimination, and physical
and mental health consequences of the abuse: the real cause is the socially
constructed culture and space of competition, individuality, injustice, racism,
patriarchy, sexism, homophobia, and corporate control of people’s (including
children) identity and desires. The World Health Organization states “enacted
legislation has
placed the responsibility of prevention on the shoulders of organizational
(educational or workplace) management with no apparent input expected from the
public health sector” (17). This must stop as we re-think the role of
public health professionals and public health frameworks for public policy and
social norms. The intervention #WeAreAllWorthy is a multidimensional campaign
and movement the crucial function of understanding social networks, allyship,
the urge for safe spaces, good citizenship, and the prevention, protection, and
respect of basic human rights for all (freedom of expression, freedom of
speech, freedom from persecution and violence, etc.) in the fight against
bullying.

Intervention Defense 1: #TakingControl

First
and most essential, the campaign must be understanding and appealing. For
victims and allies, the intervention should not just be a policy or a new rule
or a new punishment for against their bullies and only in the classroom. The
intervention should be a movement that gives the victims of bullying the
control and autonomy that they lost from the abuse. It’s important to note that
in order for this movement to be appealing, it must be as inclusive as
possible. Using the Diffusion of Innovation Theory (16), it will start with
victims and their friends/siblings, but as soon as enough people consume the
product (or join the movement), then everybody will join as well. This movement
will be called #WeAreAllWorthy, #TakingControl. It would be not only a social
media campaign and also a very comprehensive, well-developed curriculum in
schools. The program would be branded (using Advertisement and Marketing
Theories) with a positive message, nothing about victims but about survivors,
not about bystanders but about allies, not about individuals but about a team.
The curriculum would have an extra class with discussions on different mental
health and community development topics, collective reflection, safe space
discussions, and conversations on diversity, acceptance, respect, body image,
stereotypes, etc. It would also have an anonymous confidential section where
students could speak to a peer ally and also a counselor about their experience
with youth violence or abuse.

Another
key point of this intervention is that the leaders of this movement will be
older peers who stand as allies to the younger student survivors. Malcom
Gladwell’s The Tipping Point (10)explains that “all epidemics have
tipping points,” as soon as a specific number of students join the movement and
become part of the campaign, everybody else will also join. Studies have shown
that in schools with severe bullying problems, students believe and are
committed to peer support systems, and teachers have a mostly positive view of
the intervention (3). Furthermore, Maslow’s Hierarchy of Needs explains that
unless students have their basic needs met—including safety, community,
belonging, love, etc., then asking them for personal development and
understanding of others is not realistic or reasonable. This is why the
campaign would have to address basic needs: after water, housing, food, there’s
family, community, security—these are the most important requirements for
children to develop as community members and leaders: belonging and love.

Intervention Defense 2: #AllyForSafeSpace

The
most critical point to address when including the bullies and victimizers into
the campaign above is to acknowledge the high probability that they have of
having been victims themselves, and of understanding the social norms and also
social community, environmental, psychological causes of their actions and
behavior. The victimizers would also be part of this campaign and group
counseling sessions—and it is essential that these conversations foster core
values of love, security, equality, role models, safety, and belonging. Older
kids will be trained and serve as the leaders of these groups along with mental
health professionals and teachers—however, these older “cool” or more popular
kids will be the ones passing the message on, with the theme and title
#AllyForSafeSpace, as Social Expectations Theory (2) has shown that people are
social beings, they depend on and follow those who they deem more fit, more
popular, more able, more attractive, more intelligent, etc. If this campaign
has as leaders, trained and educated older kids who will serve as mentors for
younger peers and talks to them about the above-mentioned topics, then it is
more likely to be attractive to young victimizers instead of a campaign where
the teacher reprimands all students who participate in aggression.

There’s
another important point to mention: discrimination and aggression against
sexual minority though is significantly higher than among heterosexual
populations. Homophobic bullying is pervasive among children and adolescents in
schools- as well as in workplaces:

“Students who frequently experience homophobic
bullying are at an elevated risk of several negative outcomes, including
depression anxiety, hostility, mental health symptoms, health problems poor
school functioning school absenteeism, substance use risky sexual behaviors
post-traumatic stress disorder self-harm and suicidal behavior…. Researchers
and practitioners have recognized the importance of a framework that considers
assessment of risk and protective factors beyond the individual-level, as
emerging evidence suggests that certain environmental factors have a profound
effect on homophobic bullying in school… There’s been some initiatives for
interventions in an ecological system of individual, micro, exo, and macro
actions and campaigns.” (17, 20)

Intervention Defense 3: #PassItOn

The
last point of this intervention would be a mass media campaign with celebrities
and personal stories aimed not only at changing kids behavior but also parents
and teachers’ behavior and attitudes with regards to their everyday lives.
These adults are examples/role models for their kids, and because of the
intersectionality of this problem—with racism, homophobia, discrimination,
individualism, etc. Parents and teachers thus will therefore learn from
celebrities about bullying, good citizenship, the extra class, and the
vulnerability of their kids to any form of mental and physical aggression by
other kids (because of Optimism Bias, they didn’t think their kids would be
bullied…). The message for teachers will also talk about the damage of bullying
and of allowing for a normalized level of youth violence in schools, because
studies have proven that “Teachers with stronger beliefs that bullying is
normative were less likely to intervene to stop bullying, and lack of
intervention was in turn related to higher levels of peer victimization in
their school” (8).

The
most important part of this campaign is that the message is not shooting
statistics and blaming adults of bad-parenting, but it’s going to show them,
with subliminal but well-structured messages, how to act in front of their kids
to be more consciencious about their words, behavior, and actions with regards
to race, gender, respect, violence, and conflict resolution. This campaign will
appeal to strong core values of family, equality, and safety, and it’ll be
successful due to Agenda Setting Theory (22) and also to Advertisement and
Marketing theories (mentioned above).

Conclusion

It’s important to
change the framing of this issue of bullying and stop blaming the victim,
punishing the victimizers with no rehabilitation or dialogue, and start
including parents, older kids, friends, and teachers alike in the movement to
end stigma, end discrimination, and end youth violence. “The scientific literature suggests that preventative interventions
should include whole community awareness campaigns about the nature of bullying
and its dangers. Efforts should also be made to enhance the emotional and
organizational environments in school and work settings by promoting
sensitivity, mutual respect and tolerance to diversity while prohibiting
bullying” (17). It is also important to remember that referral to appropriate
health services will be required to alleviate the physical and emotional
consequences of bullying. This campaign is branded; it’s a movement that people
want to join, belong to, and share stories in. Through social and behavioral science theories that aim to
change the community’s behavior, through marketing and branding, and through
understanding the multisectorial aspect of the problem, the #WeAreAllWorthy
campaign will end all the failures of the StopBullying.gov initiative. Let’s
#JoinTheMovement!

Justice is not served best with a singular
solution. For the United States, the path to justice is undeniably intertwined
with incarceration. Compared to all other nations of the world, with a
staggering 2.2 million inmates, the United States possesses the largest
imprisoned population in the world (1).
America’s most populated state (2), the Golden State, California played a
major role in augmenting the nation’s incarcerated population over the last
twenty years. Enacted in 1994, California’s Proposition 184, or as the infamous
piece of legislation is also titled, the “Three Strikes and You’re Out” policy
was crafted with the intent of deferring repeat criminal offenses. As the title
denotes, under the “Three Strikes” policy, Californian criminals are punished
relative to the amount of felony offenses they have committed. Repeat offenders
receive twice the sentencing length otherwise mandated by law for their second
offense and a third offense leads to a life imprisonment with the minimum term
being 25 years (3).
The law catalyzed a tremendous influx of jailed prisoners in California since
its enactment. Beyond the ethical and legal dilemmas posed by the Proposition
184, the law offers profound implications for the public health sector of
California. In particular, the incarceration of criminals suffering from severe
mental illness creates a need for systematic reform.

Examining the “Three Strikes” policy
through the lens of behavioral science provides a medium to address the disenfranchisement
of mentally ill prisoners in the state of California. One of the nation’s most
prestigious academic institutions, Stanford Law School has launched the
discussion regarding Proposition 184’s role in the imprisonment of the mentally
ill with their publication “When Did Prisons Become Acceptable Mental Health
Care Facilities?” According to Stanford’s extensive report, approximately 45
percent of Californian inmates are suffering from a mental illness. The most
alarming disparity highlighted in the report is the disproportionate number of
inmates sentenced to life in prison under the “Three Strikes” law. Prisoners
sentenced under the “Three Strikes” law are nearly twice as likely to be mentally
ill compared to other California prisoners (4).
Rather than establishing public institutions that assist the mentally ill
prisoners combat their diseases, the state of California is shackled by its
inadequate criminal justice legislation, the “Three Strikes” policy. Stemming
from such inadequate policies, a vicious cycle plagues people who are mentally
ill not only in California, but also the entire nation. In the fractured mental
health care system of the United States, people diagnosed with severe mental
illnesses face tremendous barriers to receive the necessary medical care to
manage their illness. When severely ill patients are left untreated, the
unfortunate reality of their illness manifests in the form of erratic and
illegal behavior (5).
With a policy such as the “Three Strikes” rule, mentally ill criminals are
relegated to serving as cogs in the vicious cycle of repeated imprisonment and
neglected treatment. Indicting Proposition 184 with several evidence-based
social and behavioral science theories can bring the Golden State closer to
justice.

Issues
of Stigma

Consider the trajectory of a
prototypical civil rights movement. Each civil rights trajectory can be placed
in the confines of a narrative with heroes and villains. With each civil rights
narrative, the villain is continually embodied by an ominous social phenomenon
– stigma. Ervin Goffman, one of the most influential sociologists of the 20th
century, was a founding scholar in the examination of stigma as a social
concept. By Goffman’s foundational
account, stigma is a reference to a social attribute (race, occupation,
religion, sexual orientation, educational status etc.) that is labeled as
“deeply discrediting” by the “normals,” or exclusive factions in a society (6).
Stigma plagues the socially discredited in a cyclical fashion. As Patrick
Corrigan outlines, stigma unfolds in a three-part act: signals, stereotypes, and
discrimination. Physical characteristics and language exuded by the stigmatized
provide signals for exclusive members of society to construct stereotypes about
discredited factions. With the stereotypes on the conscious of the elite, the
discredited faction is subject to confront discrimination in various arenas of
social life (7). As investigative journalism published in the New York Times
reveals, the “Three Strikes” policy has created a medium for California to
stigmatize the mentally ill.

Dale Curtis’ confrontation with the “Three
Strikes” policy exemplifies the villainous nature of stigma. Curtis is a 55
year-old, Californian male who suffers from mental retardation and
schizophrenia. Multiple non-violent, robberies of negligible monetary values
committed by Curtis earned him three strikes in the California court of law.
The tragedy of stigma ultimately confronted Dale Curtis in the courtroom.
Although Curtis displayed severe episodes of mental impairment during
questioning and with the negligence of his public defense attorney to mention
his extensive record of illness, Curtis was awarded the status quo, life sentence
for his third strike (8).
Corrigan’s three-part act of stigma was exemplified in the case of Dale Curtis.
Through his actions in the courtroom, Curtis provided the surrounding audience
signals to justify stereotypes and discriminatory sentencing. Despite the
clearly visible signs and records available to validate Curtis’ illness, the
court opted to discredit his illness and ignore mental health care treatment
options. Addressing issues of stigma can alter the tragic course of mental
illness in California to form a story of triumph & redemption.

The Role of Social Norms

Before detrimental stigmas around
mental illness can be resolved, there is a pressing social issue underlying the
phenomena of stigmatization. Perceived social norms of mental illness are at
the foundation of the injustice perpetuated by the “Three Strikes” policy. Social norms are beliefs shared within a
social environment (school, occupational setting, church, city, etc.) regarding
a set of behaviors or “customary codes.” The theory of planned behavior
explains the potential for social norms to impact communities. Before an
individual can reach an intention to facilitate a certain behavior, the
attitude that individual holds toward the particular behavior is influenced by
the prevalent social norms in an environment (9). The perceptions individuals
share of one another and the nature of social interactions are tremendously
impacted by the prevalent social norms shared in an environment. Social norms have
the potential to influence the manner that human beings treat one another. Stigmatizing
and discrediting social norms regarding mental illness can further complicate
disparities of mental health among individuals in a social setting.

One recent study featuring a cohort of
undergraduate students demonstrates the role perceived social norms have in the
stigmatization of mental illness. In the study’s primary experiment, the
students were asked to describe their level of comfort to interact with
individuals who display symptoms of schizophrenia and depression, as designated
by the Diagnostic and Statistical Manual of Mental Disorders. Before the
investigators assessed the subjects’ comfort in the hypothetical scenarios,
they assessed the subjects’ perceived social norms of behaviors and personal
beliefs related to mental illness using questionnaire instruments. Ultimately,
the analysis revealed an association between subjects reporting less comfort
with interaction among mentally ill people and perceived normative expectations
about general behavior (10). The study validates the role of social norms in
the stigmatization of mental illness. If people approach those battling a
mental illness with discrediting preconceived notions, the ill are subject to
face discrimination and stigma. Dale Curtis’ story mirrors the conclusion of
the social norms study. Curtis’ symptoms and history of illness were subsequently
discredited and approached with tremendous social distance, or an ambivalent
interaction based on a set of collectively recognized norms in a social group (11).
Perhaps, discrediting institutional norms regarding mental illness were at the
foundation of Dale Curtis’ stigmatized experience.

Frames that Make the Mentally
Ill Invisible

Perspectives surrounding the
implementation of the “Three Strikes” policy and subsequently proposed
amendments completely ignore the role played by California’s criminal justice
system in the manifestation of mental illness. With the aid of framing theory,
California’s ignorance toward the mental health of its inmates can be brought
to the forefront. Framing is the manner
in which information is packaged and arranged to convey an intended
connotation, or message is framing (12). Polarizing issues, such as policies
surrounding incarceration and the treatment of mental illness, evoke a vast
spectrum of frames in the media and political forums. In the construction of
public policies, framing creates a significant impact on the perspective of
voters and politicians in their consideration of issues debated in legislative
arenas. One of the fundamental tasks in frame analysis is identifying the core
values, or the “appeal to principle” offered by a frame presented in the media.
Core values are terms that link the underlying position of the frame and its
attempt to resonate with an ideal that is ubiquitously valued in society (13).
With the use of core values, frames have the power to influence which values
and beliefs are instilled within a society. In the case of the “Three Strikes”
policy, the frames surrounding the policy neglect to include health as a core
value.

Proposition 36 is the most recent proposal
on behalf of California’s legislature to mend the oversight embedded within the
“Three Strikes” policy. Established in 2012, Proposition 36 raised the valid
concerns of revising the “Three Strikes” policy to save the state money and
continue to ensure the safety of its citizens. One glaring piece was missing in
the frames constructed to support Proposition 36 – an emphasis on the mentally
ill prisoners who are marginalized by the “Three Strikes” policy. Safety,
justice, and economics are core values disseminated throughout Proposition 36’s
website Fix Three Strikes. The highlighted potential benefits of the proposition
include: “saves California over $70-100 million annually,” “restores the
original intent of the Three Strikes law,” and “no rapists, murders, or child
molesters will benefit from Prop. 36”(14). While public safety, resurrecting
California’s budget, and incarcerating legitimate felons are valid concerns
built upon core values that resonate with the public, there are no statues in
Proposition 36 that speak to the mental health burden of inmates. As the
Stanford report examines, the lack of attention devoted to the mentally ill
that are incarcerated under “Three Strikes” sentencing has consequences. While
nearly 1800 prisoners reaped the benefit of gaining a revised sentence
following the Proposition 36 approval, 75 percent of the inmates denied a
revised sentence after the proposition was passed were mentally ill (4).
Proposition 36 was an opportunity to leverage the influence of framing theory
to afford the mentally ill who are imprisoned by the “Three Strikes” a path to
seeking treatment. The unfortunate reality is that frames in support of
Proposition 36 neglected health as a core value and the negligence continues to
haunt prisoners struggling with illness. Frames provide an outlet to bring an
issue, not unlike prisoners battling mental illness, from subterranean media
and advocacy circles to the center of mass media. With the use of health and
equality focused frames, citizens imprisoned by mental illness will be granted
a previously absent voice and platform in the conscious of the public.

Campaign to Address Social
Norms & Stigmatization

Mental health is gaining momentum in
reaching the center of public health interventions and awareness campaigns. On
the other hand, outreach and campaign efforts specific to mental illness within
the criminal justice system are incredibly scarce. Invisible social issues,
like the oppression of the mentally ill through imprisonment, require drastic
social measures to foster legitimate social change. In the plight of the
mentally ill who are imprisoned, establishing a campaign to raise awareness of
Proposition 184’s role as an oppressor is the necessary social measure. Marketing
principles can lend the necessary tactics to construct an effective campaign
aimed at debunking stigma and reframing social norms of mental illness among
the incarcerated. Social marketing, in particular, is a theoretical model
pertinent to what would best assist the design of a mental illness social norm
campaign. The ultimate goal of social marketing is to garner effective
campaigns by utilizing principles of commercial marketing (product planning,
pricing, communication, and marketing research) to leverage influence on the
acceptability of social ideas and norms. To achieve significant social change,
the principles of commercial marketing must address historical, cultural,
political, and social environments surrounding an issue (15). Each component,
or tool offered by social marketing can be applied to the predicament of the
mentally ill affected by the “Three Strikes” law to design an effective social
norms campaign.

Historically, California has struggled with
transitioning from the deinstitutionalization of mental illness in the 1960’
s-1970 and subsequent “emptying” of the
ill released from closed state hospitals to prisons during the proceeding decades
(4). While California legislature has
offered several policies to address mental health, such as the Mental Health
Services Act in 2004, politically the state has been silent on issues of mental
illness among the incarcerated. Considering the stigma encountered by Dale
Curtis in the courtroom, the social environment in California surrounding
mentally ill criminals is not one of reconciliation. With the historical,
political, environmental, and social factors surrounding the “Three Strikes”
law in mind, social marketing tools can be leveraged to design an effective
campaign aimed at changing the social norms regarding mentally ill prisoners.

Building a social norms campaign with a
product, price, place, promotion, and partnership as the pillars of
intervention is paramount in the design phase. In particular, considering the
product disseminated in social media, television, and print campaign materials
will foster the most relevant campaign to a 21st century audience. The
product, or an immediate benefit (15) to be acquired by the audience (the state
of California) in the case of the norms campaign is an abstract commodity –
social purpose. For instance, in promotional material, the issue of
incarcerating the mentally ill can be framed as the current generation’s
marquee civil rights issue. To illustrate the campaign’s product, compiling images
of mentally ill persons in hospital gowns behind prison bars with images of the
1960’s civil rights movement, or the AIDS movement of the 1980’s will add
historical relevance to the campaign. Like previous generations, the current
generation can acquire social purpose by participating in a social movement.
Politically, the campaign can engage the audience by instituting a pledge for
Californians to call on their representatives and senators to craft legislative
action that aids the mentally ill whom the “Three Strikes” law repeatedly
oppresses. If the historical and
political components are successful, the goal of systematic social change will
follow. With social marketing, a social issue can be afforded a social
resolution and newfound visibility.

Establish Multi-Dimensional
Care Options

Mental
illness is an immensely complex issue that requires multi-faceted solutions. Combine
the difficulty of managing a mental illness with confronting the criminal
justice system on a regular basis, and the issue becomes even more baffling. Maslow’s
“Hierarchy of Needs” is a behavioral model that resonates with the complex and
multi-dimensional nature of mental illness. Utilizing Maslow’s hierarchical
model as a platform to design treatment programs for mentally ill and legally
troubled populous, such as those affected by the “Three Strikes” policy,
provides an outlet to compartmentalize a densely faceted issue. Abraham Maslow
devised his theory to identify the most fundamental human needs, which when
fulfilled, can lead to the achievement of “self actualization.” The diverse
array of human needs highlighted by Maslow includes: physiological, safety,
love and belongingness, esteem, and self-actualization. If all of the
fundamental needs are met, individuals theoretically reach an empowered state of
being that spawns the development of critical thinking and problem-solving
abilities (16). Addressing the “Hierarchy of Needs” for the mentally ill poses
a valid model to provide coordinated care to mental health patients and assist
those who frequently confront the law assimilate into society, rather than
prison.

On a national scope, there are
examples of health care facilities that provide treatment options to assist
mentally ill patients meet their “hierarchy of needs.” Bridgeview Manor is an
adult care home in Ashtabula, Ohio that provides mental health treatment to
patients suffering from severe mental illnesses who have also served prison
sentences. The facility was featured in PBS’ Frontline documentary series, “The Released,” which depicts the
plight of mentally ill prisoners in the United States. In Frontline’s interview with the Bridgeview Manor director, Sherri
Sullivan, she acknowledges the mentally ill patient’s unique need for
assistance with routine tasks (physiological needs), such as practicing daily
hygiene and preparing meals. Regaining connection with family members (love and
belongingness), access Social Security and Medicaid Benefits (safety), and motivational
interventions (esteem) are other services that Bridgeview Manor offers to
patients. Sullivan also noted about the
patients at Bridgeview, “they need a lot of additional help that's not
available particularly in an outpatient community setting” (5).
Although operating a facility like Bridgeview Manor poses significant funding
and administrative challenges, the facility offers an outstanding example of how
mental health patients leaving prison should be treated. If California
allocated more resources in community settings to address the unique “hierarchy
of needs” for the mentally ill, versus imprisoning the ill as a substitute for
treatment, self-actualization for the mentally ill can be realized.

Enhance Public Defense &
Police Mental Health Training

Modifying the norms of an
institution is approachable through the use of individualized behavioral
models. To prevent future instances of stigma within legal forums, such as the
case of Dale Curtis, bolstering mental health training programs for criminal
justice authorities in California is a viable solution. For the design of such
training programs, social cognitive theory provides a behavioral framework to
assist legal authorities transcend prejudice thought regarding mental illness and
embrace social differences in their line of work. Social cognitive theory (SCT)
is a dynamic behavioral model that focuses on the relationship between
individual factors, environmental variables, and subsequent human behavior. At
the core of SCT, is the classic nature-versus-nurture debate – are individuals a
product of their environment, or is the environment a product of the
individuals? According to SCT, the adoption of new behavior causes both the
onset of social modifications that alter the individual and the environment
(17). In the plight of the mentally ill affected by the “Three Strikes” law,
the previously suggested interventions are aimed at creating environmental, or
macro-level social changes. California’s individual, or micro-level solution: adopt
SCT-modeled training programs for figures in the state’s criminal justice
system. Through the use of a SCT model, law enforcement, judicial, and
correctional professionals can develop the self-mastery to constructively interact
with mentally ill persons, to recognize symptoms of illness, and to identify
safe and ethical methods to coerce untreated individuals experiencing
heightened states of illness.

Patrick Corrigan also presents
thought provoking literature regarding the dynamic between social-cognition,
institutional stigma, and life-chances for the oppressed. Corrigan expresses
the dynamic in a formulaic manner. As a product of social cognitive function,
authoritative individuals exercise institutional stigma, which pressures
society to undermine access to care (18). Because of pressures in the courtroom
(environment) and the negligence of the judicial and legal professionals
(individuals), Dale Curtis did not receive equal due process (discrimination
and stigma). Expanding mental health training programs for California’s
criminal justice system will reconcile the environmental and individual
elements in Dale Curtis’ narrative. The National Alliance for Mental Illness
(NAMI) offers one of the most comprehensive law enforcement mental health
training programs in the country – Crisis Intervention Training (CIT). With a
bi-dimensional program design, CIT combines an individual component: “training
for law enforcement to improve response to people experiencing a mental health
crisis;” and an environmental component: “a forum for partner organizations to
coordinate diversion from jails to mental health services” (19).
CIT focuses on social cognition by intervening the approach of individual
police officers and the approach of communities, or larger social environments
to treating mental illness. By addressing the individual and environmental
components of the SCT model, the CIT program is a shining example of an
alternative approach to incarceration of the mentally ill.

Conclusion

Managing mental illness is an immense
challenge for both individuals and societies. The complexity of addressing the
issue is beyond daunting. In the world of criminal justice, the complexities of
mental health serve as an excuse to perpetuate the oppression of the mentally
ill through imprisonment. Embracing social differences will allow societies to
mitigate the consequences of inadequate and antiquated policies, such as the
“Three Strikes” policy. Campaigns to address social norms, establishing more multi-dimensional
community mental health care facilities, and funding criminal justice mental
health training programs, are viable interventions to address the systematic
disenfranchisement of the mentally ill in California. Social endeavors are a
balance of exercising patience and urgency. Profound societal change does not
transpire instantaneously, yet the consequences of injustice do not rest.

Children
with special needs receive various responses from families and communities all
over the nation. There have been many attempts to reduce the discrimination and
improve these children’s quality of life. Trisomy 21, or Down syndrome, in
particular has experienced discrimination fueled by ignorance that needs to be
reversed. A general approach that is taken to improve these children’s lives is
the use of individualized therapy sessions, separated classroom settings, and
distinctive learning goals (1). There is only so much that these interventions
can accomplish in the physical, mental, and social growth of a child with Down
syndrome. Here, we will examine flaws with these types of programs and how to
improve the details to reach a more favorable outcome in developmental
abilities and learning outcomes.

Current
Approach

There
are numerous programs throughout the U.S and the world that are dedicated to
the wellbeing and health of children with Down syndrome (1)(2). It is very important
to ensure their overall health is assessed and that they are not at risk for
heart and growth complications. Clinical and classroom settings that set these
individuals apart from those without developmental delays are not beneficial
after a certain age. Separated facilities should not be the lifelong focus for
individuals and families with Down syndrome. As they grow older and remain
healthy, they develop social and interpersonal needs as well. These are clearly
represented in Maslow’s Hierarchy of Needs and it is completely logical that
this would also apply to individuals with Down syndrome (3). Many approaches
that are in place today focus only on the physiological and safety levels,
which are helpful, but severely restrictive in lifestyle. The focus now,
especially for adolescence, should be the belonging, the self-esteem, and the
self-actualization levels. This really is just as important, if not more important
to children with Down syndrome in order to feel like they are capable of the same
things that anyone else is. Here are a few ways that many current approaches do
not support these long-term needs.

Argument
1

When
a parent discovers that their child has Down syndrome, whether it be prenatally
or at the time of birth, they often feel like this is their personal problem
and that they have to do something about it right away. Fortunately, the option
of termination is becoming much less popular, but it does still exist (4).
Parents and families make assumptions about what their child’s lifestyle and
even their own lifestyles will be like throughout the child’s life. There are
aspects of Leon Festinger’s theory of Cognitive Dissonance playing a role here.
This theory states that an event that brings about a feeling of discomfort causes
someone to want to take action in order to bring back a sense of comfort and
balance (5). Parents may feel that the presence of Down syndrome is something
that has disturbed their idea of consistency and that they need to adjust it to
make it go back to normal. It is perfectly reasonable for a parent to want to
take action to improve their child’s life, but sometimes over-action or
over-care can be just as detrimental to the child’s future. However, parents
and families often receive skewed messages of how to handle and work with a
child with Down syndrome and that it should be particular and distinctive from
a child without a developmental delay. This pre-conceived notion that special
care is needed is often exaggerated and does not give enough credit to the
child. When children are given too much extra attention and special care that
other children their age do not receive, it creates something of a barrier
between them and their peers. This is not the goal; we want children with Down
syndrome to feel as if they are not treated differently and that they can
accomplish what anyone else can. This presence of support and motivation is
helpful, but it must come with appropriate motives. There are definitely
benefits that come from these programs, but they are only part of what should
be going on.

Argument
2

Another
flaw with these approaches is the pressure that is put on parents to fix
things. Health care professionals and other organizations are using some seemingly
inspirational techniques from the Theory of Planned Behavior. These ideas
include enforcing certain attitudes upon people about a behavior to change and
what the perceived norms are of doing that behavior. These are combined with
intention and self-efficacy, and it assumes that behavior change will automatically
be made (6). The idea of treating the growth of a child as the behavior to
change is not appropriate. Parents often feel like they can fix this problem
and lessen the negative effects that it has, or even use the technique to
aspire to be in the norm. A few flaws with this theory are that it is encouraging
parents to make a change in their child’s life with the wrong purpose, and it
is not very useful for long-term behaviors or actions. This is precisely the
case with children with Down syndrome. For a parent to want to “fix” their
child based on perceived norms about what their child should be like is having
a skewed intention of what is best for them. The intention behind the use of
this theory is admirable, but the information being put across is not what we
want parents to hear and relate to. This would involve parents being adamant about
sending their eight-year-old child to a specialized classroom that is separate
from everyone else and that only includes other students with developmental
delays. The intention is present and there is self-efficacy for doing the right
thing, but the deprivation of being around other children is definitely disadvantageous.
The individualization of this approach is what constricts the mental and
developmental growth of these children.

Argument
3

Finally,
those who implement these programs and health plans for parents with Down
syndrome realize that taking action and continuing to take action throughout
their child’s life is a way of being in control over something that happened
against their will. Down syndrome is not a desired outcome, so this allows for
them to be able to take some action and feel good about it. The programs and
systematic interventions intended for children with special needs to undergo
are restrictive of long-term goals and benefits. Being able to make a
difference in how one’s child is raised and treated may give the illusion of
control. This is a proposed theory by Ellen Langer that explains how people
tend to prefer feeling like they have control over a situation even when that
may not be the case (7). However, by doing so and trying to control and mediate
the experiences a child growing up with Down syndrome has, it really ends up
taking away from the more positive practices and skills that they could learn
on their own with less interference. As with the majority of parents, having
control over teenagers is desirable but quite difficult. Adolescents with Down
syndrome should be able to experience freedom to explore and be able to learn
from these same environments. Not only will this improve their social skills
and self-esteem, but they will thrive in the situations they are put in because
they will be able to work and solve problems more efficiently, thus boosting
their self-esteem.

Overview

All
in all, individualized programs have good intentions and they are appropriate
to ensure the health of a child with Down syndrome early on. However, there
comes a point when these programs are restrictive and do not help children
advance as far as they could if they were in more typical settings. By using
influential explanations of behavior change, the skills that these children
learn are constrained rather than allowed to flourish. Shifting these kinds of
program to using more social models will allow more growth among adolescents
with Down syndrome and their peers.

New
Intervention

As
a typical child grows older, he or she ideally develops friendships and
experiences that serve as pivotal social situations to growth and learning.
Preventing a child from experiencing these necessary components of childhood is
a great disservice to their social skills, particularly in a child with Down
syndrome. Christopher Kliewer helps explain that there are so many factors that
can change the way they experience the world and the opportunities that they
are given (8). One way to do this would be to ensure that children with Down
syndrome and other special needs are able to socialize and relate with other
children that can help advance their development. Our new intervention will be
based primarily in classrooms of elementary schools, middle schools, and even
high schools. In order for them to flourish socially and psychologically,
inclusion is key. Students with Down syndrome will have some individualized
attention to assist with their academic success, such as reading, writing, and
mathematics, but they will spend a large portion of their day with the same
schedules and classroom time as everyone else. This integration will not only
help them learn better and adapt to their environment, but their classmates
will be able to collaborate and work with them in order to provide a stronger,
more close-knit environment. In addition, it is really important for
adolescents with Down syndrome to not feel cast aside or alienated from their
classmates. Setting all the children on a more socially balanced level will
allow them to feel as if they have equal opportunities to succeed and
participate. This intervention of inclusion and integration will help these
individuals to feel assisted based on their needs, but with the freedom to explore
and expand their limits and goals.

Defense
1

The
first flaw in current approaches was about the message being given to parents
to do the right thing and take steps to fix the problem that they have been
presented with. The parents care very much, but we need to redirect this energy
in the proper direction for something more positive. Individuals with Down
syndrome are capable of many things, so long as they are given the chance. Our
intervention will have an effective way of showing parents a different
perspective on what their child’s life can be like and how Down syndrome does
not have to obstruct their dreams. This message will be particularly effective
when it comes from someone who means it and understands what a parent’s role
is. It should also be someone that parents can connect with and look up to for
comforting guidelines and encouragement. For this, we would use Down syndrome
advocates Eva Longoria, with her own organization, Eva’s Heroes, Jamie Foxx, who
is a stakeholder at the Global Down Syndrome Foundation, and Lauren Potter, the
Glee actress with Down syndrome (9). Longoria
and Foxx both have sisters with Down syndrome and they have had personal
experiences with being told to take the assumption that their respective
sisters would not live fulfilling lives, but they were given countless
opportunities anyway and they have accomplished great things and lead happy
lives (10)(11). This is the message we want to portray to encourage parents who
may not know what Down syndrome entails and how to best “fix” it. Potter can go
further to explain what her lifestyle is like and the opportunities she
received throughout childhood that help her thrive. With these messages, we are
employing Robert Craig’s Communication Theory, which simply shows that if an
audience feels connected with the communicator, they will be much more likely
to take the information to heart and understand it better (12). Seeing these
celebrity advocates will have a familiarity factor and parents will be better
persuaded to enrich the opportunities for their own child.

Defense
2

The
next step we want to take is to fix the issue that stands regarding making a
change to improve their child’s life. Instead of using an individual-centered
intervention based on the Theory of Planned Behavior, we need to look at
society and the environment and adjust how they function in those situations. We
will use the Social Expectations Theory founded by Joseph Berger, which helps
our goal by showing that a behavior is best formed by being done in large
groups that can be imitated (13). By spreading our campaign advertisements,
billboards, and posters all over the nation, we will be able to inform many
people and transform the idea of inclusion of all people with special needs.
Down syndrome will be better known and there will likely be much less
discrimination. Changing the norm is really going to speak to parents and
families and help them feel more comfortable with the idea of raising a child
with Down syndrome. It will also improve the ways that current approaches
attempt to solve the problem of having to take action right away. This campaign
will help change people’s mindsets, which will change their behavior, which
will spread very quickly. This process will take a snowball effect and it will
be so rewarding for parents to feel secure about the ambitious lifestyles their
children can have and that they do not have to be limited in any way.

Defense
3

Finally,
we want to completely reverse the meaning of control. Parents should definitely
be able to experience control, but so should their children. As they grow
older, they are already aware that they are different from other people, so
this should not be reinforced by the system. The environment needs to be
welcoming and accepting of everything they want to do. The control that was
dubbed an illusion will now become more concrete with the implementation of our
campaign and there will be confidence in what they can accomplish. The idea of
this control will duplicate that of the progress Down syndrome has made in the
nation in the last 50 years. Michelle Sie Whitten, the Executive Director of
the Global Down Syndrome Foundation, illuminates this timeline and how things
have changed. Prior to the 1980’s, individuals with special needs in general
were often institutionalized just for being different and this brought about
the assumption that they were not capable of living like “normal” humans. It
was assumed that it was impossible for them to carry out regular activities
like eating, dressing, communicating, and living past 28 years of age. After
these practices were considered inhumane and the focus shifted, individuals
with Down syndrome were living at home, attending schools, and living in
everyday society. This dramatically increased the IQs of people with Down
syndrome, life expectancy to about 60, and many are educated and employed (14).
This is outstanding progress that serves as a more extreme example of what is
being done today; these children and adolescents should no longer be limited to
confined classrooms and other settings where they are not integrated with the
rest of society. There is clearly vast potential among these individuals that
we need to expose and share with families and communities everywhere. This will
be the real control that not only we should have, but that we can give to those
with Down syndrome who have goals and desires of their own.

Conclusion

It
is clear that individualized methods alone are not helping children with Down
syndrome reach their full potentials, and that viewing them as having a
developmental disability will only hinder their abilities. This group-based intervention
will help change that stigma and make the population realize that they can be
integrated into normal school systems and be treated with the same amount of
respect and knowledge. The initial push is beneficial for them when they are younger,
but parents and families must feel more optimistic about their lives. Integration
and acceptance into society will provide that guidance for all individuals with
Down syndrome to reach new limits and accomplish more than anyone thought they
could.

REFERENCES

(1)Buckley
SJ. Developing the speech and language skills of teenagers with Down